Secure Loan Application Exit to Loan Page 
 
LOAN APPLICATION
 P.O. Box 085300 Racine, WI. 53408
Married applicants may apply for a separate account. If you are applying for Individual Credit, you must complete the Applicant section about yourself and the Co-Applicant section about your spouse if:
  1. Your spouse will use the account, or
  2. You are relying on your spouse's income as a basis for repayment.

If you are relying on income from alimony, child support or separate maintenance, complete the Co-Applicant section to the extent possible about the person on whose payments you are relying.If you are applying for Joint Credit with another person, complete the Applicant and Co-Applicant sections.

INDIVIDUAL OR JOINT REQUEST

This is an individual credit request based on the creditworthiness of the below applicant only.

This is a joint credit request based upon creditworthiness of both applicants listed below. Both applicants intend to sign the loan documents and both will accept responsibility for repayment of the loan. Both applicants are aware of this  election.
TYPE AND AMOUNT OF CREDIT YOU'RE REQUESTING
Amount/Credit Limit Requested: $
Approximate Time to Repay: How Many? Periods:
Loan Type:
Security Offered: (for secured credit only)
Type of Credit: Individual Joint
Your Email Address:
PAYMENT PROTECTION COVERAGE
Check if desired Check coverage(s) desired. We will disclose the cost of this Payment Protection Insurance - Credit Disability and Credit Life - to you. A separate enrollment form which discloses the terms and conditions must be signed for coverage to become effective.
Do you want your loan protected for you and your family if you become disabled? Yes No
Applicant   Co-Applicant
Name:
Email: 		Name:
 
CU Account #: CU Account #:
Social Security #: Social Security #:
Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state (AZ,CA,ID,LA,NM,NV,TX,WA,WI,Puerto Rico):
Married Separated
Unmarried (Single - Divorced - Widowed)		 Please indicate your marital status if you are applying for Joint Credit, secured credit or if you live in a community property state (AZ,CA,ID,LA,NM,NV,TX,WA,WI,Puerto Rico):
Married Separated
Unmarried (Single - Divorced - Widowed)
Driver's License #: State:   Driver's License #: State:
Birth Date: Birth Date:
Home Phone:
Business Phone: 		Home Phone:
Business Phone:
Present Address:



Years There: Own Rent 		Present Address:



Years There: Own Rent
DEBTS DEBTS
Mortgage/Rent owed to:   Mortgage/Rent owed to:
Balance (Mortgage only): Balance (Mortgage only):
Monthly Payment:
Current APR % (Mortgage only): 		Monthly Payment:
Current APR % (Mortgage only):
Person Responsible for Payment: Person Responsible for Payment:
INCOME INCOME
Employer:   Employer:
Income: $ Net Gross
Annual Monthly Bi-weekly Weekly
  		Income: $ Net Gross
Annual Monthly Bi-weekly Weekly
 
Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source:
$ Annual Monthly Hourly 		Other Income: (Notice: Alimony, child support or separate maintenance income need not be revealed if you do not have it considered as a basis for repaying this obligation.)
Source:
$ Annual Monthly Hourly
By submitting this loan request, you agree that the information is correct to the best of your knowledge. You also agree to notify us of any changes to your name, address or employment.You authorize the credit union to obtain credit reports in connection with this request.